The Relationship Between Fetuin-A?FGF23 And Clinical Prognosis In STEMI Patients

Objective: To investigate the relationship between Fetuin-A?fibroblast growth factor 23(FGF23)and clinical outcomes of acute ST-elevation myocardial infarction(STEMI)patients compared with the GRACE risk score.Methods: A total of 259 STEMI patients undergoing percutaneous coronary intervention(PCI)at the Heart Center of Lanzhou University First Hospital from November 2011 to November 2016 were selected.In addition,83 patients with negative coronary angiography were selected as negative control.Clinical data,blood routine,blood biochemistry,NT-ProBNP,echocardiography and application of clinical drugs were collected.Peripheral blood FGF23 and Fetuin-A level was detected.Follow-up STEMI patients by telephone for 1 year,and the end-point event were defined as All-cause Mortality.Based on whether occur with cardiogenic shock during hospitaliztion,the STEMI group was divided into CS-group(130 cases)and Non-CS group(129 cases).According to whether the end-point event occurred or not during follow-up,STEMI group was divided into two subgroups: death group(25 cases)and non-death group(234 cases).Results :1.After matching age,gender,smoking,hypertension,diabetes and other cardiovascular risk factors,FGF23 levels of STEMI patients were significantly higher than healthy negative control[(0.47±1.06pg/ml)vs(6.70±17.11pg/ml),p<0.001].Fetuin-A levels were not statistically different between the two groups.2.Compared with Non-CS group,CS group had significantly higher levels of FGF23 [(10.37±22.51 pg/ml)vs(3.00±7.21 pg/ml),p=0.001];significantly lower levels of Fetuin-A [(1243.45 ± 902.38 ng/ml)vs(2229.12 ± 1676.08 ng/ml),p <0.001].Compared with the non-death group,death group has significantly lower level of FGF23 [(28.80±42.34 pg/ml)vs(4.34±9.03 pg/ml),p<0.001];significantly higher level of Fetuin-A [(886.61±821.83ng/ml)vs.(1824.95±1452.30ng/ml),p<0.001].3.25 patients dead(9.73%)at the end time of follow-up.Univariate COX regression analysis showed that older,faster heart rate,higher white blood cells,higher AST?ALT,higher creatinine?urea nitrogen,higher FGF23?NT-ProBNP,higher TnI and low blood pressure,low LVEF,low Fetuin-A are prognosis risk factors for STEMI Patients.Multivariate cox regression analysis revealed that FGF23 ?10.725 pg/ml is independent risk factor for STEMI Patients' prognosis(HR=3.744,95% CI 1.670-8.393,p=0.001).Fetuin-A ? 1035.80 ng/ml is independent protect factor for STEMI Patients' prognosis(HR=0.323,95% CI 0.119-0.881,p=0.027).4.The areas under ROC of Fetuin-A,FGF23,NT-ProBNP and GRACE risk score in predicting predicting end point events in STEMI patients were 0.762,0.780,0.879 and 0.895 respectively.When Fetuin-A bind with FGF23,areas under ROC curve improve to 0.835,slightly lower than the predictive value of the GRACE risk score.When Fetuin-A bind with and FGF23 and NT-ProBNP,areas under ROC curve improve to 0.933,better than the predict value of GRACE risk score.Conclusion: 1.This study confirmed that older age,faster heart rate,higher white blood cells,higher AST?ALT,higher creatinine?urea nitrogen,higher NT-ProBNP?hypotension,and low LVEF are risk factors for clinical outcome in STEMI patients.2.The lower the evel of Fetuin-A and the higher the level of FGF23,The higher the risk of end point events in STEMI patients within 1 year.3.The combination of Fetuin-A,FGF23,and NT-ProBNP can improve the predictive value of end-point events in STEMI patients,which is better than the predictive value of GRACE risk score.